Conflicting advice re. DS's asthma.

[DishwasherDogs]

Ds has asthma that is usually well controlled, but for some reason since December has been having lots of blips.
He is currently on ventolin, clenil and serevent. Next step will be seratide but the GP wants to wait and see, as this is a stronger inhaler and may be unnecessary if this is a temporary blip.

Last year ds saw an asthma nurse at the hospital.
His advice during a blip is:-
Do not increase clenil/serevent, as it will take a couple of weeks before the increase has any effect, so will not help short term.

Increase ventolin to up to 10 puffs (that's the maximum, if he needs more he gets steroids and is monitored in hospital) every 4 hours then tail it off after the blip, as it has a cumulative effect, so should stick with every 4 hours or risk the attack getting worse.

GP advice:-
Increase clenil and serevent to double the amount, then decrease once ds is better.

It doesn't matter if ds misses a ventolin dose as it doesn't have a cumulative effect. Obviously if he's wheezy he needs inhaler.

I'm confused as to which advice to follow.
I am having issues at school because when I ask for ds to have his inhaler at lunchtime (as per asthma nurse advice), they forget, ds doesn't like to ask (he is on the spectrum for ASD and will not say if he's feeling ill, will not ask for his inhaler), and comes home coughing more.
The GP says this is fine, the asthma nurse says not.

Whose advice is right?
Do I go in to school and insist that ds has his inhaler during these times and it's not ok to forget (the teacher doesn't have to do anything, apart from tell ds to go to the office to take his inhaler, but he won't yet take responsibility for himself and do this unless told), or just go with it and make sure he can have his inhaler on the way home?

[DishwasherDogs]

Anyone?

[Runningtokeepstill]

Try ringing Asthma Uk on their helpline 0800 121 62 44 open 9 - 5.
When ds1 was a child we were sometimes given conflicting or incorrect advice when he was having a flare up. His usual Gp and hospital consultant were great but whenever he saw someone else things went to pot. I remember a junior doc in the Paediatric clinic wanting to double the steroid inhaler when ds was already, aged 10, on the maximum adult dose. I queried it as I'd already talked to Asthma Uk before the appointment and when the junior doc checked with the consultant she said no and prescribed montelukast/Singulair tablets. This revolutionised night times for ds as it helped damped down the symptoms.

Best to be tactful if querying gp/nurse or other health professional's advice though.

[DishwasherDogs]

Thank you, I never bought of that.
Unfortunately singulair is out as ds had nasty side effects from it.

[DishwasherDogs]

*thought

[Sirzy]

I have always been advised pretty much the same as the asthma nurse said with regards to the preventer inhaler.

For school get in touch with the school nurse and get a personalised care plan. DS needs ventolin every day at school but as it is in his care plan there is no issue as they have to follow that

[CostaLotta]

Your GP is wrong! You increase your reliever (salbutamol) and your preventer stays the same. If you are needing to use salbutamol more than 3 times a week when he is well then your preventer needs to be looked at and possibly increased. If you think your GP isn't managing properly then you could ask for referral to a Paediatrician. Hope this helps. (Children's Community Nurse here!)

[CostaLotta]

Asthma UK is a great resource for advice too. With regards to school, he shouldn't have salbutamol as a routine dose every day, but they should recognise when he needs it, eg if he is coughing a lot. Also if he needs it prior to PE that should be given without exception. Agree with the prev poster who said he should have a care plan that school adhere to, your asthma nurse should be able to provide this.

[CostaLotta]

oh just noticed one more thing, yes ventolin doesn't have a cumulative effect, but the effects of it last a maximum of 4 hours so if he misses a dose during an attack then he won't have any reliever on board IYSWIM

[HeyMicky]

They're both right.

A 'blip' will be preceded by up to 15 days of increasing issues. So while the preventer will take 2 weeks to make a difference, as the nurse said, if you're keeping an eye on low level symptoms you can increase the preventer and avoid the exacerbation. So you're doctor is right there. But if you miss the symptoms you'll be dependant on the reliever

I'd speak to doctor about reviewing the action plan, and look at ways to track usage, either via an app or on paper

[DishwasherDogs]

When he's well he rarely needs ventolin, so it's not a routine thing generally.
When he has an attack, or a cold (which usually goes to his chest) we routinely give him ventolin on the advice of the nurse, it usually does the trick.
This time it's not clearing, he doesn't have any indications of it being an infection, but he's not having his inhaler at lunchtime at school - I don't know if that would make a difference, probably not, reading above?

He is seeing the paediatrician in April, the earliest appointment available.

At the moment he is coughing rather than wheezing. Breathing sounds more difficult, but he's not wheezing, but having the inhaler helps it. He's been to the GP like this, who has looked puzzled and said that he's fine, yet he's still not breathing freely, which is reflected in his peak flow measurement.

He's not a child who is ever straightforward, that's for sure!

[DishwasherDogs]

X post. I think we're definitely missing symptoms.
We regularly do peak flows and keep track of it so we can hopefully spot a blip, but so far it seems to be something that comes on very quickly (the GP at one point mentioned brittle, not sure if this is why?)
He will go from being symptomless (or symptoms that we're not seeing) to coughing very quickly, and if we don't nip it in the bud gets fairly bad quite quickly.

[Runningtokeepstill]

If things deteriorate quickly and ds is already not responding well to his current regime, I'd be tempted to ring up the hospital and ask if there are any earlier paediatric appointments or possibilities of cancellations, particularly if brittle asthma has been mentioned as a possibility. Again Asthma Uk would be a good starting point.

I'm not sure how old your son is. My ds1 generally got steadily worse from starting with asthma at 10 months (hospitalisation and diagnosis) until he was 10 and started on singulair (sorry, I know this doesn't work for your ds).
However, around 11 he started with lots of other allergies including a very severe and rare-ish (in the Uk anyway) allergic eye condition plus, periods of severe coughing which lasted for days and didn't respond to asthma medication. In his case it wasn't brittle asthma but a response to some environmental allergen that got him producing so much mucous he would cough pretty much continually for 3 days or so before it settled down. Then a few days later it would all start up again. He'd often be sick and it was so bad he was once admitted to hospital with suspected whooping cough, although he was found not to have this. They sent him home and advised "symptom control" which would have been great if we'd ever found anything that did control it.

It all settled down after he'd gone through puberty at around the age of 15/16. But up until then he missed loads of school although much of this was due to the eye condition and the need to spend days in a darkened room.

The bit of good news (for those boys who are the lucky ones) is that statistically more boys find their asthma gets better after puberty. Here's hoping for your ds,